Interventional radiology as a fine art

Abstract

The era of new systemic treatments of hepatocellular carcinoma (HCC) has yet to come. Hepatocarcinogenesis and liver cancer could be subjected to biomodulation in the near future [1] but up to now the treatments of HCC are still local or locoregional and rely on either surgery, percutaneous ablation, or different variants of chemoembolisation [2,3]. Progresses in the field have been slow but not negligible. Although still debated, indications for liver transplantation or resection have been refined and mostly restricted [4]. In western countries where underlying liver disease is present in almost all cases of HCC and reaches the stage of cirrhosis in 90%, interventional radiology has taken a predominant position as a curative or palliative option [2,3]. New percutaneous ablation techniques now enable to destroy small tumors with a margin of surrounding parenchyma up to 8–10 mm [2]. But curiously results are still reported without taking into account techniques and operator’s skill. Radiofrequency ablation (RFA) which is almost universally considered as the best ablative technique is more diverse than surgery and more rapidly improving. However, technical requirements that seem now evident for surgery have still to be admitted for RFA, particularly experience and skill of the operator. Comparisons between techniques and probes have been scarce [5]. In the near future multipolar multiprobe RFA will make well-limited large tumors eligible for the technique and more importantly allow ablation of small tumors detected by screening using a safety